Guidance for Management of Anesthesia & Airway Devices Using Enhanced Infection Control Measures Preparation of the OR Induction of Anesthesia Extubation & End of Case Red Zone Patients: Perform RSI, no mask-ventilation. Perform routine extubation/LMA removal planning - Ensure full NMB recovery - Anti-emetics recommended Extubation sequence: - Consider using a blue chuck or towel to cover the patient?s mouth during extubation (as a barrier for aerosolization) - Retain HMEF on ETT/LMA during extubation - Deflate ETT and extubate along with the towel/chuck - Dispose of used disposable supplies (ETT, temp probe, bite block, OPA, NG/OG tube, suction) using the dirty contaminated bag - Do NOT throw away laryngoscopes , keep in sealed plastic bag inside the OR for anesthesia technician collectio Specimen/plastic bags/bucket: - 1 bag/bucket for used laryngoscope - 1 bag for used facemask & syringe - Ensure you are able to retrieve them if needed during the case. PPE during Airway Management: - Hospital approved N95 respirator + eye protection + double gloves - All providers including anesthesia, nursing staff, airway assistants Airway Management Enhanced Infection Control Measures_v7. 11/01/2020. Yellow Zone Patients: A routine induction, RSI or modified RSI may be performed in this patient group; gentle mask ventilation if indicated Green Zone Patients: ensure patients keep their surgical masks on during MAC/sedation, if appropriate. The surgical mask should be placed under a simple oxygen mask (which is preferred over nasal cannula to reduce droplet spread Immediately following intubation: - Used laryngoscope should be placed into a plastic bag/bucket and sealed. - Inflate ETT cuff BEFORE applying PPV - Dispose of outside/dirty gloves immediately, before touching the ventilator - Secure ETT, as usual - Facemask and syringe should be stored in separate plastic bag and sealed Immediately following insertion of LMA/i-gel® - Dispose of outside/dirty gloves, before touching the ventilator - Secure LMA, as usual - Facemask should be stored in separate plastic bag and sealed Remove the patient?s surgical mask Preoxygenate as usual (5 minutes of spontaneous breathing/4 vital capacity breaths) ALL ZONES Post Induction - Ensure drugs/syringes are not placed onto the anesthesia workstation/airway tray, these items should remain separate from possible contamination of used airway equipment Large cassette/plastic bag: - For used items that come into contact with the airway, e.g.: oropharyngeal airway, temp probe, bite block, OG/NG tube, suction, used ETT. - Fix to the head of the bed, onto the sheet. Avoid fixing this to a hard surface, the adhesive glue may be left behind and prevent thorough cleaning. Pre-prepared pieces of tape to secure the ETT - Please do not use a roll of tape as this cannot be placed back afterwards and will be thrown out. Prepare OR as usual, with the addition of the following: At the end of the case: - The trash/cassette bag & contents can be rolled up and discarded. Refer to our online COVID-19 resources & educational videos for more information (https://www.anesthesiaeducation.net/qsi_covid19/) Process Process